Provider Demographics
NPI:1033313812
Name:ARCHIBALD, PAUL CLIFFORD (MA, LCSW-C)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:CLIFFORD
Last Name:ARCHIBALD
Suffix:
Gender:M
Credentials:MA, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1431 E BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-1405
Mailing Address - Country:US
Mailing Address - Phone:410-342-4130
Mailing Address - Fax:410-342-4130
Practice Address - Street 1:1431 E BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-1405
Practice Address - Country:US
Practice Address - Phone:410-342-4130
Practice Address - Fax:410-342-4130
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD112831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD008353400Medicaid